Stanford Medicine surgeons perform first ever transplant with still beating heart

por John R. Fischer, Senior Reporter | April 25, 2023
Cardiology Operating Room
Surgeons at Stanford Medicine have for the first time ever implanted a heart without having to shut it down prior to surgery.
Surgeons at Stanford Medicine have performed a first-time feat by transplanting a still beating heart into a patient, reducing the risk of cardiac tissue damage and subsequent decreased survival outcomes associated with stopping the heart.

Performed for the first time in October, the surgeons have since completed the procedure five more times in adult and pediatric patients by quickly transitioning the heart to a cardiopulmonary bypass machine already supporting the patient, ensuring an uninterrupted flow of oxygen.

The hearts came from donors who died by cardiac or circulatory death, with the organ in those instances often shutting down once naturally or when life support is cut off. Medical teams will reactivate them by hooking them up to a heart in the box machine, which perfuses them with oxygenated blood, until right before a transplant, at which point surgeons shut the organs down a second time to implant them in patients. Each shut down subjects the heart to oxygen deprivation, which for prolonged periods can impair performance.

While procedures with hearts from these types of patients often result in poorer outcomes, they are necessary for widening the limited demand of hearts available for transplants.

Not stopping the heart a second time allowed patients to recover faster and leave the hospital sooner.

"This technique will enable improved short and long-term outcomes such as length of stay in the ICU, decreased need for advanced mechanical support post-operatively, and overall improved heart function. These will ultimately translate to improved utilization of resources and decreased cost," Dr. Brandon Guenthart, clinical assistant professor of cardiothoracic surgery at Stanford, told HCB News.

The team performed the first procedure using a heart in a box solution to transport the organ, and kept the machine there for backup in case the procedure, which lasted four hours, proved too difficult.

The surgeons, who intend to publish the details of the technique for widespread adoption by other surgeons, say that all six patients are doing well, and that while it will be a long time before they can demonstrate the long-term benefits they say are associated with the technique, it will have “innumerable” benefits.

They also are evaluating procurement and implantation strategies in both sheep and pig models in the lab, as well as studying and optimizing ex vivo heart perfusion technologies and devices to find ways to perform transplants without stopping the heart at all.

"Together with improvement in surgical techniques and the devices that support the heart outside the body, we believe that in the future we will be able to perform heart transplantation with a continuously beating heart from start to finish," said Guenthart.

The findings were published in the Journal of Thoracic and Cardiovascular Surgery Techniques.

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